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Outcome of 200 Pediatric Living Donor Liver Transplantations in India
Neelam Mohan1, Sakshi Karkra, Amit Rastogi
1Department of Pediatric Gastroenterology, Hepatology and Liver transplant, *Pediatric Intensive Care Unit, #Institute of Liver Transplant and Regenerative Medicine, and $Department of Radiology; Medanta -The Medicity, Gurgaon, Haryana, India. Correspondence to: Neelam Mohan, Department of Pediatric astroenterology, Hepatology and Liver transplant, Medanta - The Medicity, Gurgaon, Haryana, India. drneelam@yahoo.com.
Insights
Pediatric living donor liver transplantation in India achieved excellent outcomes, with a 5-year survival rate of 87%. This study shows that low infant age and weight are not contraindications for successful liver transplants.
Area of Science:
- Hepatology
- Pediatric Surgery
- Transplantation Medicine
Background:
- Pediatric liver transplantation is a complex procedure with varying outcomes globally.
- Living donor liver transplantation (LDLT) offers a viable alternative when deceased donors are unavailable.
- India has a growing experience in pediatric LDLT, necessitating a review of its outcomes.
Purpose of the Study:
- To report the 12-year experience of pediatric living donor liver transplantation (LDLT) in India.
- To analyze the demographic features, indications, donor/graft profiles, and outcomes of these transplants.
- To assess the impact of patient age and weight on transplant success.
Main Methods:
- A retrospective analysis of 200 pediatric living donor liver transplants performed between September 2004 and July 2016.
- Data collected included patient demographics, indications for transplant, donor characteristics, surgical complications, and patient survival.
- Statistical analysis was performed to compare outcomes based on patient weight and disease severity.
Main Results:
- 200 LDLTs were performed on 197 children, with mothers being the most common donors (51%).
- Leading indications included cholestatic (46%), metabolic (33%), and acute liver failure (28.5%).
- Overall 1-year survival was 94%, and 5-year actuarial survival was 87%, with no significant difference based on weight (<10 kg vs. >10 kg).
Conclusions:
- Advances in multidisciplinary care and surgical techniques have led to excellent outcomes in pediatric LDLT.
- Low infant age and weight do not appear to be contraindications for successful liver transplantation.
- This experience highlights the feasibility and success of pediatric LDLT in India.
Objective:
To describe our experience of pediatric living donor liver transplantation from India over a period of 12 years.
Materials And Methods:
A retrospective analysis of 200 living donor liver transplantation in children (18 years or younger) was done for demographic features, indications, donor and graft profile and outcome.
Results:
Between September 2004 and July 2016, 200 liver transplants were performed on 197 children. Fifty transplants were done in initial 6 years and 150 in next 6 years. All donors (51% mothers) were discharged with a mean stay of 7 days. The leading indications of liver transplants were cholestatic liver disease (46%) followed by metabolic liver disease (33%) and acute liver failure/acute on chronic liver failure (28.5%). Biliary leakage (8.5%), biliary stricture (9%), hepatic artery thrombosis (4.5%) and portal vein thrombosis (4%) were the most common surgical complications; all could be managed by surgical or interventional radiological measures, except in one child who died. Sepsis, acute rejection and CMV hepatitis in first 6 months were seen in 14.5%, 25% and 17% cases, respectively. Post-transplant lymphoproliferative disease was seen in only 1.5%. Re-transplant rate was 1.5%. The overall 1 year survival rate was 94% and 5 year actuarial survival was 87% with no statistically significant difference between children weight <10 kg vs. >10 kg. Outcome in acute liver failure did not differ significantly between those with acute on chronic liver failure vs. those with chronic liver disease.
Conclusions:
Advances in medical and surgical techniques associated with multidisciplinary teams including skilled pediatric liver transplant surgeons, anesthetists, dedicated pediatric hepatologists, pediatric intensivists, interventional radiologists and pathologists resulted in an excellent outcome of living related liver transplants in children. Low age and weight of the baby does not seem to be a contraindication for liver transplantation as outcome were comparable in our experience.
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